Opposite of cerebral programs

[Purulent DC]

Unlike the previous post, I am looking for clinically oriented programs that are full of trauma and acuity, with little drawn-out pontification of subtle medical management (except during the critical care/ unit rotations), and minimal off service floor work (but O.R. time would be welcome). Base on this criteria, what would your top list be?

I have interview offers from the following programs. Many fit the above criteria, but others don't. I need to pair down this list in the next few days. Any suggestion of programs to eliminate because they might be light on trauma and heavy on fast track?

Cook County
U Mass
Baystate
UMDNJ Camden
Temple
Drexel
Pitt
Kings County Brooklyn
Jacobi
BID/Albert Einstein NYC
St.Lukes/Roosevelt
LA County- USC
Alameda County/ Highland
Davis
Fresno
Oregon
Orlando
Duke
Michigan

Thanks for the input!

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[The White Coat Investor]

I would eliminate USC. That place is such a cushy weenie residency. Those guys have ancillary staff to do their fingernails! There is almost zero penetrating trauma. The volume of the hospital is like 10,000, so they never see any good pathology. Maybe we could recommend that one to the guy looking for a cerebral program.


You should eliminate Highland, Cook County, Fresno, Davis, and Brooklyn for the same reason. I think combined they had 34 traumas all last year.

 

[GCS:3]

Check for programs with no floor months. None of the programs on your list jump out at me, but I know U of Chicago and Jefferson have this setup. I'd rather have an MICU month than a ward month anytime. You still have rounds, but at least the patients are sick.

 

[frog4brooke]

I have not been to visit the Duke EM program-but I do wonder if Duke is the kind of program you are looking for. I say this just based on the population in the area-lots of highly educated, professional folks. While the triangle does have some bad portions I do not think that the volume of trauma will compare to say Cook Co.

Just a hunch-Maybe some one will speak up if I'm wrong.


Best of Luck-

B

 

[Purulent DC]

Thanks for the feedback.

Desperado, I think you might be onto something regarding USC. I was just browsing their ED residency webpage and kept running into phrases like: "country club living," "elite clientele," "mandatory three hour lunch breaks," and "golf in the afternoon." The sections on valet parking for the residents and subsidized housing in Malibu and Beverly Hills should have clued me in. From what I've heard, they do actually get an occasional penetrating trauma, but it's primarily iatrogenic, mostly due to nail file accidents during the manicures.

 

[Pelivar]

I interviewed at temple last week and I would say they meet your requirments well. They have the most penetraying trauma in pennsylvania (and they remind you of that a million times). They also do 5 months of ICU, including PICU, MICU, Burn ICU, Trauma ICU and a CT sugery ICU and they say you get some surgical time in the burn and surgical ICUs. They seemed to work hard and their teaching was more on the practical side than the cerebral. Also Bob McNamara is the PD which I think would be helpful when you graduate.

-P

 

[Apollyon]

Originally posted by frog4brooke
I have not been to visit the Duke EM program-but I do wonder if Duke is the kind of program you are looking for. I say this just based on the population in the area-lots of highly educated, professional folks. While the triangle does have some bad portions I do not think that the volume of trauma will compare to say Cook Co.

Just a hunch-Maybe some one will speak up if I'm wrong.

The weapon du jour in Durham is the shotgun. An officer told me the crime rate per capita in Durham is higher than Baltimore (but not the murder rate), but the base population is lower. The highly educated people that come in include the guy who almost cut his finger off with a circular saw last night. One thing that amazes me is the acuity of the cases that roll in, that don't have the coordinate number of nonacute cases to accompany them. To see people this sick elsewhere, the volume of trivial cases would be overwhelming (like in New York or Chicago). One other good thing is it's the only game in town - beyond the primary cases, we get a LOT of transfers from outside facilities for their trauma, and you would be amazed to see what DOESN'T get done. I'm satisfied, and I'm a former "ghetto medic".

The people from upstairs might cogitate for a while, but, if you think Duke is soft and cerebral, you're wrong. Consider Mayo and Geisinger for parallels.

 

[ERMudPhud]

I have to agree with looking for a program that requires the least amount of floor time. Denver's program used to have your only inpatient months in the ICU's but now that they have added their own internship I imagine there will be some significant floor time during the internship year. I think its important in looking at any program's curriculum to make sure that every off service rotation actually offers some benefit. If you're acting like a med student or just rounding and writing notes on post-op patients your aren't learning much.

 

[deleted6669]

scratch ohsu(seriously). very academic/snooty program with minimal trauma exposure. several better trauma ctrs within 10 min.

 

[Scrubbs]

Drexel, Temple and Cooper definately fit the bill... Drexel is pretty well known for being a more clinical program. We rotate through 5 hospitals, which gives us about 200K pt/yr, and we get tons of exposure in every kind of setting (community to university). We get really good pathology, and interns are encouraged to see the sickest of the sick. We have no med/surg months, and about 6 months of ICU over the 3 years. Also, our ICU is pretty unique, since the team is all EM people (3 interns, 2 second years, 1 third year with an attending). While we're in the unit, we also run all of the codes in the hospital, which is pretty intense.

Nuf said... I'll let someone else pontificate about Temple and Cooper.

 

[NinerNiner999]

Don't forget about Jacksonville, FL. Their program is Resident-run with minimal off-service time. They claim to have the highest acuity in Jacksonville, which is the largest city (in square miles) in the United States. Very similar to Emory and Cook County. #4-5 Trauma volume in the US.

 

[e2kschultz]

My 2 cents.

Intern that just got off the interview trail, I chose MLK-Drew in LA for precisely that reason: high acuity, great penetrating trauma (middle of South Central LA, gangland), minimal floor work (1 month Wards), with very practical teaching. Almost entirely resident-run program. The 2nd years run the critical area, which is like a mini-ICU.

As for the programs down there:
USC is not a country club. I don't know where anyone got that idea. They get plenty of trauma.

King's county, Jacobi and Licoln are the only programs in New York City that get any serious trauma anymore. St. Luke's is level 1 but they get almost no trauma (rotated/interviewed there). Beth Israel gets even less (they do a few months at St. Luke's)

e2k

 

[docB]

I don't know why anyone would say that UC Davis doesn't see much trauma. It's about 90% blunt but there's more than you'd ever want. 20+ trauma activations a night easy. I went to med school at Temple and residency at Davis and I'd say that Davis saw more trauma although Temple had a much higher percentage of penetrating trauma.

BTW Davis only does 1 month of med wards in all 3 years.

 

[Apollyon]

Originally posted by e2kschultz
King's county, Jacobi and Licoln are the only programs in New York City that get any serious trauma anymore. St. Luke's is level 1 but they get almost no trauma (rotated/interviewed there). Beth Israel gets even less (they do a few months at St. Luke's)

I must have just been lucky when I was neck-deep in blunt and penetrating trauma at Elmhurst. That's also why BI and North Shore come to Elmhurst to do their trauma.

 

[The White Coat Investor]

As for the programs down there:

USC is not a country club. I don't know where anyone got that idea. They get plenty of trauma.

I don't know why anyone would say that UC Davis doesn't see much trauma.

Its called sarcasm people. I thought I could safely use some of the biggest knife and gun clubs in the west as my examples and no one in their right mind would think I was serious.

 

[roja]

I am going to have to disagree about St. Lukes. In my first year, and 6 weeks in the main ED, I have seen extensive trauma. Guy with half his face blown off, stab wounds, all kinds of stuff.
Knife/gunshot wounds are down across the country. There are definately areas where it is more than others. But we see plenty at Lukes.

Kings County doesn't have a lot of trauma, but they put out strong residents adn they do everything. (at least in the month I rotated there)

 

[AznTrojan]

did they give you the scoop on how the lack of surgical residents will affect their ER program??

Originally posted by e2kschultz
My 2 cents.

Intern that just got off the interview trail, I chose MLK-Drew in LA for precisely that reason: high acuity, great penetrating trauma (middle of South Central LA, gangland), minimal floor work (1 month Wards), with very practical teaching. Almost entirely resident-run program. The 2nd years run the critical area, which is like a mini-ICU.

As for the programs down there:
USC is not a country club. I don't know where anyone got that idea. They get plenty of trauma.

King's county, Jacobi and Licoln are the only programs in New York City that get any serious trauma anymore. St. Luke's is level 1 but they get almost no trauma (rotated/interviewed there). Beth Israel gets even less (they do a few months at St. Luke's)

e2k

 

[kungfufishing]

so, you mean when you make that sarcasm you say something that you dont really mean? now who ever heard of somethin like that?

 

[Sheerstress]

You guys are hilarious...

 

[anonymousEM]

As a current resident in Jacksonville, I'd have to agree that we have great pathology. Trauma is high acuity and flown in from Georgia and all of NE FL. Floor months aren't too bad, one IM as an intern then MI as an EM1 and 2, PI EM 2 Trauma EM 1 and Trauma ICU EM3. CCU was eliminated at the residents' request as it was no longer a valuable experience. I think more amazing than the trauma volume is the volume of SICK medical patients...end stage everything. We've had a few senior residents recently from MAYO that came to rotate for the trauma experience and have noted their surprise at the medical acuity. If you're looking for a hospital with "Country Club Living" this isn't it...but you can live at the beach and will graduate able to handle ANYTHING.